TITLE:
Telemonitoring of Patients with Implantable Cardiac Devices to Manage Heart Failure: An Evaluation of Tablet-PC-Based Nursing Intervention Program
AUTHORS:
Aya Umeda, Tomoko Inoue, Takuri Takahashi, Hidetoshi Wakamatsu
KEYWORDS:
Heart Failure; Telemonitoring; Telenursing; Remote Monitoring; Implantable Cardiac Devices
JOURNAL NAME:
Open Journal of Nursing,
Vol.4 No.4,
April
9,
2014
ABSTRACT: Background: With the
rapid aging of society, the number of patients with heart failure has also increased.
Implantable devices for heart failure have become standardized. Remote
monitoring using cardiac devices has grown in popularity for medical efficiency
and the early detection of abnormalities. Our first aim was to develop a tablet-PC-based
nursing intervention program for patients requiring remote monitoring of implantable
cardiac devices. The second purpose was to evaluate the efficacy of the program
by using mixed-methods research. Methods: The study consisted of two phases. In
phase 1, we designed a tablet-PC-based nursing intervention program, on the
basis of a literature review and qualitative data collected via semi-structured
interviews. In phase 2, we conducted a randomized controlled trial that served
as a preliminary investigation of the program. The outcome measures were
readmission, unexpected visits to the clinic for heart problems, quality of
life, self-care behavior, and self-efficacy. After the study, we interviewed
each participant about his or her experiences with the program. Interviews were
audio recorded, coded, and thematically analyzed. Results: The 33 patients with
heart failure were randomized into two groups as follows: 17 patients in the telenursing
group and 16 in the control group. During 6 months of follow-up, the
readmission for heart failure occurred in 11% of the intervention group and 18%
of the control group. There were no statistically significant differences
between the groups at any outcome measures. Three themes were extracted via
qualitative analysis: “getting a sense of safety,” “triggering a health
behavior change,” and “feeling like a burden.” Conclusion: No improvements in
rates of rehospitalization or unexpected clinic visits were seen in the quantitative
study. However, signs of behavior modification were seen in the qualitative
study. This program has the possibility of improving patient outcomes.